Surgical instrument for suturing blood vessels with u-shaped staples

ABSTRACT

A surgical instrument for suturing blood vessels with U-shaped staples, has two supporting semibushes whose cylindrical surface has depressions for staples to be deformed, and two staple semibushes that embrace the supporting semibushes from outside so that an annular gap is left therebetween to accommodate the walls of the blood vessel being sutured. The staple semibushes are provided with radial slots, wherein staple-magazines are movably mounted; the magazines have staple recesses and staple ejectors located inside said magazines. The instrument is provided with mechanical actuators to impart radial motion to the magazines and staple ejectors. The end of a blood vessel is everted as a cuff on the assembled supporting semibushes and on the blood-vessel end so everted, the other end of the blood vessel to be sutured on is disposed in overlapping relation, whereupon the staple semibushes are assembled embracing the overlapping region of the blood-vessel ends. Suturing is performed in a single motion by causing U-shaped staples to eject from the staple magazines. The ejected staples penetrate the overlapping walls of the bloodvessel and get deformed by impinging against the depressions on the supporting semibushes. Suturing performed, the semibushes are disassembled and the surgical instrument withdrawn.

United States Patent Razgulov et al.

(451 Feb.'5, 1974 SURGICAL INSTRUMENT FOR SUTURING BLOOD 'VESSELS WITHU-SHAPED STAPLES [76] Inventors: Mikhail Mikhailovich Razgulov,

ulitsa Trudovaya, l-a, kv. l8, Elektrostal Moscovskoi Oblasti; GeorgyVasilievich Astafiev, Rizhsky proezd, 7, kv. 108; Ivan AlexandrovichKorolkov, Polyarnaya ulitsa, 52, korpus 2 kv. 174, both of Moscow, allof U.S.S.R.

[22] Filed: Jan. 28, 1972 [21] Appl. No.: 221,656

Primary Examiner-Granville Y. Custer, Jr. Assistant Examiner-Harold P.Smith, Jr. Attorney, Agent, or Firm-l-lolman and Stern [57] ABSTRACT Asurgical instrument for suturing blood vessels with U-shaped staples,has two supporting semibushes whose cylindrical surface has depressionsfor staples to be deformed, and two staple semibushes that embrace thesupporting semibushes from outside so that an annular gap is lefttherebetween to accommodate the walls of the blood vessel being sutured.The staple semibushes are provided with radial slots, whereinstaple-magazines are movably mounted; the magazines have staple recessesand staple ejectors located inside said magazines. The instrument isprovided with mechanical actuators to impart radial motion to themagazines and staple ejectors. The end of a blood vessel is everted as acuff on the assembled supporting semibushes and on the blood-vessel endso everted, the other end of the blood vessel to be sutured on isdisposed in overlapping relation, whereupon the staple semibushes areassembled embracing the overlapping region of the blood-vessel ends.Suturing is performed in a single motion by causing U-shaped staples toeject from the staple magazines. The ejected staples penetrate theoverlapping walls of the blood-vessel and get deformed by impingingagainst the depressions on the supporting semibushes. Suturingperformed, the semibushes are disassembled and the surgical instrumentwithdrawn.

4 Claims, 9 Drawing Figures SHEET 1 or 3 PATENTEU FEB 5 74 SURGICALINSTRUMENT FOR SUTURING BLOOD VESSELS WITH U-SHAPED STAPLES BACKGROUNDOF THE INVENTION Field of The Invention The present invention relatesgenerally to medical equipment and has particular reference to surgicalinstruments for suturing blood vessels using U-shaped staples which areapplicable for suturing a variety of blood vessels such as veins,arteries, the aorta, etc., as well as other hollow organs of a livingbeing.

DESCRIPTION OF THE PRIOR ART Known in the present-day surgical practiceis a surgical instrument for suturing blood vessels.

Said known instrument consists of two parts, viz., a supporting bodypart and the other comprising staples.

The supporting part accommodates two interchangeable supportingsemibushes having depressions adapted for bending the staples. One ofthe supporting semibushes is fixed on the supporting body, while theother, on a carrier strip. The supporting body and the carrier strip,when brought together, form the supporting part of the instrument, whilethe supporting semibushes in the assembled position form a cylindricalsleeve or bush, whose bore is adapted to accommodate the vessel beingsutured.

The staple part comprises two interchangeable staple semibushes, ofwhich one is fixed on a staple body and the other, on the carrier strip.

The staple body and the carrier strip, when brought together, form thestaple part of the instrument, while the staple semibushes in theassembled position likewise form a cylindrical-shaped staple bush whosebore is adapted to accommodate the vessel being sutured.

Depressions for deforming and bending staples are located on an end faceof the supporting semibushes. Located along the staple semibushes andparallel to the generatrix of the cylindrical surfaces thereof, arestaple recesses open from the 'end face of the semibushes. Each of thestable recesses accommodates a U-shaped staple, whereas locatedtherebehind is astaple ejector. The staple recesses in the staple bushare arranged quite similarly to those located on the end face of thesupporting bush.

The supporting and staple parts of the instruments are interconnectedthrough a special lock. With the supporting and staple partsinterconnected, the supporting and staple bush are located with theirend faces towards each other.

The distance between the end faces of the staple and supporting busheswhich distance is essentially a suturing gap adjustable to suit the wallthickness of the vessel being sutured, is varied by means of theaforesaid lock interconnecting the staple and supporting parts of theinstrument.

A reciprocating motion is imparted from the staple ejectors lengthwiseof a staple recess by means of a a special lever.

The instrument has also two pinchcock clamps (also referred to ashaemostatic forceps) to arrest blood flow and two collar clamps toretain the everted vessel ends on the supporting and staple bushesduring stitching.

The known instrument operates as follows.

The vessel ends are 'freed from the surrounding tissues and exposed fora required length which depends upon the height of the supporting andstaple bushes next, one of the exposed ends of the blood-vessel ispassed inside this supporting bush and everted thereupon as a cuff so asto lie as far as on the outside surface of the supporting bush, asfeasible while the other blood vessel end is placed ina similar way onthe staple bush. To prevent the vessel ends from slipping off saidbushes, said ends are secured by collar clamps. To arrest hemorrhage,the blood vessel is to be compressed by pinch-cock clamps. At thisjuncture the supporting and staple parts of the instrument are joinedtogether and closed with the lock which is also adapted to adjust thesuturing gap.

Then, levers are pressed down to actuate the staple ejectors to driveout the staples from their recesses.

The legs of the staples penetrate the walls of the vessels being sututedand, while thrusting against the bottom of the depressions made in thesupporting bush, are bent to assume the B-shape, thus firmly uniting thevessel ends.

A suture is applied in a single motion throughout the vesselcircumference, and this cuts down the suture application time by 15-30minutes. After having been su tured, the vessel ends are released fromthe pinchcock and collar clamps, and the staple and supporting bushesare disassembled into semibushes by removing the corresponding carrierstrips, whereupon the entire instrument can be taken off the suturedvessel.

However, the above-described instrument suffers from the followingdisadvantages.

The staple recesses are arranged lengthwise of the generatrix of thebush, i.e., square with the end face thereof, with the result that theheight of the staple bush is determined by the height of a staple andthe length of the staple ejector, and, therefore, cannot be reduced withthe given design particularities of the instrument.

This results in a relatively large height of the staple and supportingbushes of the known instruments, which requires that the vessel ends tobe exposed for a considerable length, viz., up to 50-60 mm which in somecases proves to be impracticable. Moreover, the known instruments failto stitch vessels excess of 20 mm in diameter, since further in; creasein the diametral size of bushes under the adapted design of instrumentwill result in a higher stitching forces to be applied which, in turn,would result in an impermissible increase in the overall dimensions ofthe instrument.

SUMMARY OF THE INVENTION it is an essential object of the presentinvention to provide an instrument for suturing blood vessels withU-shaped staples the instrument being simple in design, able to performsingle-motion suturing and having the staple and supporting bushesadapted to stitch blood vessels which need be separated from thesurrounding tissues as little as possible. The instrument besides, iscapable of suturing vessels in excess of 20 mm in diameter and featurerelatively small overall dimensions.

Said object is accomplished due to the fact that a surgical instrumentfor suturing blood vessels with U- shaped staples in accordance with theinvention, comprises two supporting semibushes having depressions forcausing staples to bend, one of said supporting semibushes being fixedto a supporting body, while the other, to a carrier strip, the twosemibushes being adapted, when assembled together, to form a supportingpart of the instrument having a cylindrical bore for the vesselaccommodating being sutured; the instrument further includes two staplesemibushes adapted to accommodate staples and staple ejectors, one ofthe staple semibushes being fixed to the staple body and the other, tothe carrier strip, the two staple semibushes, when assembled and broughttogether, forming a staple part of the instrument with a cylindricalbore for the vessel being sutured. According to the invention the staplesemibushes embrace the supporting semibushes from outside so that anannular gap is left in between the staple and supporting semibushes,said gap being adapted to accomoodate the walls of the vessel beingsutured, staple bending depressions being provided on the outsidecylindrical surface of the supporting semibushes; in said staplesemibushes radial slots located against the respective depressions inthe supporting semibushes are provided, said radial slots accommodatingmovable holders or magazines provided with staple recesses and stapleejectors located inside said magazines. The magazines and stapleejectors are provided with mechanical actuators to impart radial motionthereto, said actuators being made as the magazine and staple semirings,respectively which can swivel relative to the staple semibushes and areinterconnected with the actuating mechanisms thereof; said semiringshave sloping grooves adapted to receive shanks provided on the magazinesand staple ejectors so that swivelling motion of the magazine and staplesemirings are transformed into radial reciprocating motion of themagazines and staple ejectors, respectively.

The actuating mechanism of the magazine semirings may be made as a rodmovable lengthwise the staple body, said rod having a thread cut on oneof its ends, the thread being adapted to interact with a sliding nut,whereas a sloping groove is made on the other end of said rod tointeract with a projection made on one of the magazine semirings.

It is desirable that the actuating mechanism of the staple semirings bemade as a swivel toothed segment provided with an actuating lever, saidsegment being adapted to interact by means of its teeth with theprojections provided on the staple semirings.

It is expedient that the instrument be provided with a self-actinglimiter of the staple ejectors, to coordinate the movement of the stapleejectors with that of the magazines, said limiter being made as a stopfixed on the movable rod and adapted to interact with a curvilinearsurface of a projection provided on the actuating lever.

The herein-proposed design of the instrument makes it possible to reducethe axial dimension of bushes several times, whereby the instrumentdisclosed herein is rendered much more versatile and its capabilitiesare much higher as compared to the heretofore known suturinginstruments, mainly since the instrument of the invention requires thatthe ends of the vessels being sutured be exposed only for short lengthsviz., -10 mm as against 50-60 mm, in the case of prior art instruments.This advantageous feature makes the present instrument applicable forsuturing especially the inferior vena cava which has hitherto beenimpracticable due to too short ends of the latter.

Another advantageous feature of the herein proposed instrument residesalso in the fact that it involves the evertion of only one vessel endwhich is of special importance when badly sclerotic vessels are to besutured.

Besides, the construction of the proposed instrument is sturdy enough tomake use of bushes having such a lqiha enable ess o 19 9 m in m r to besutured.

The instrument is simple in operation and maintenance and features thesuture application time equal to 1-2 min., a sutured being applied in asingle-motion procedure.

BRIEF DESCRIPTION OF THE DRAWINGS Given below are a number of exemplaryembodiments of the present invention to be considered in conjunctionwith the appended drawings, wherein:

FIG. 1 is a schematic, partly sectional view of a surgical instrumentfor suturing blood vessels with U-shaped staples, according to theinvention;

FIG. 2 is a section taken along the line II-II in FIG.

FIG. 3 illustrates the surgical instrument as viewed in the directionthe arrow A in FIG. 1;

FIG. 4 illustrates the surgical instrument as viewed in the direction ofthe arrow B in FIG. 1;

FIG. 5 is an enlarged-scale in section taken along the line VV in FIG.3;

FIG. 6 is a section taken along the line Vl-Vl in FIG. 4;

FIG. 7 illustrates the manner of fixing a cut end of a blood vessel tothe supporting semibushes, according to the invention;

FIG. 8 shows two ends of blood-vessels to be sutured, assembled on thesupporting semibushes, according to the invention; and

FIG. 9 diagrammatically illustrates the application of the staplesemibushes to the supporting semibushes carrying the ends of the bloodvessel fixed thereto, according to the invention.

Now referring to the Figures, the instrument described herein consistsessentially of two major components, viz., a staple part 1 (FIG. 1) anda supporting part 2. Both the instrument parts are interconnectedthrough a locking strip 3 movably mounted on a supporting body 4 of thesupporting part2 so as to be free to reciprocate lengthwise of thesupporting body 4.

A rod 6 is made fast and secured on a staple carrying body 5.

When the staple and supporting parts of the instrument are broughttogether the rod 6 enters a hole 7 (FIG. 2) in the supporting body 4 sothat the end of the rod 6 having grooves 8 provided therein, is free toextend beyond the supporting body 4.

A bifurcated end 9 (FIG. 1) of the locking strip 3 enters the grooves 8(FIG. 2), thus locking the staple part 1 (FIG. 1) and the supportingpart 2 together.

The staple part 1 comprises two interchangeable staple semibushes 10(FIG. 3), of which one is fixed on the staple body 5 and the other, on acarrier strip 11. The staple semibushes 10 are fixed by means of shanks12 which enter holes 13 and 14 in the staple body 5 and in the carrierstrip 11 respectively. Each shank 12 has grooves 15 adapted to interactwith a projection 16 of a blade spring 17. i

The staple body 5 and the carrier strip 11 together with the staplesemibushes 10 when brought together, form the staple part 1 of theinstrument having a cylindrical bore 18 formed by the staple semibushes10 and adapted to accommodate the vessel being sutured. Theinterchangeable staple semibushes 10 may have any suitable outsidediameter and a required size of the bore 18 so that their size is to beselected to suit the cross sectional dimensions of the vessel beingsutured.

The staple body 5 and the carrier strip 11 are interlinked by means of alocking strip 19 mounted on the carrier strip 11 and adapted to interactwith a rod 20 which is fixed on the staple body 5 and passes through ahole (not shown) in the carrier strip 11.

Interlocking of the staple body 5 with the carrier strip 1 1 occurs in away similar to that described above with reference to the interlockingof the staple part 1 and the supporting part 2 of the instrument.

Two interchangeable supporting semibushes 21 are fixed on the supportingpart 2 (FIG. 4) of the instrument. Of these, one interchangeablesupporting semibush 21 is fixed on the supporting body 4 and the other,on the carrier strip 22.

The supporting semibushes 21 are fixed by means of shanks 23 which enterholes 24 and 25 in the supporting body 4 and the carrier strip 22,respectively. Each of the shanks 23 has a groove 26 adapted to interactwith a projection 27 of a blade spring 28.

The supporting body 4 and the carrier strip 22 with the supportingsemibushes 21, when brought together, form the supporting part 2 of theinstrument with a cylindrical bore 29 formed by the semibushes 21 andadapted to accommodate the blood vessel being sutured.

The interchangeable supporting semibushes 21 may have any suitableoutside diameter and a required size of the bore 29 so that their sizeis to be selected to suit the diameter of the blood vessel beingsutured.

The supporting body 4 and the carrier strip 22 are interconnected by alocking strip 30 mounted on the carrier strip 22 and adapted to interactwith a rod 31 which is fixed on the supporting body 4 and passes througha hole (not shown) in the carrier strip 22.

Interlocking of the supporting body 4 and the carrier strip 22 occurs asthe afore-described interlocking of the staple part 1 and the supportingpart 2 of the instrument.

When the staple part 1 and the supporting part 2 of the instrument getinterlocked, the staple semibushes 10 embrace from outside thesupporting semibushes 21 so that an annular gap is formed in between thestaple semibushes l and the supporting semibushes 21, said gap beingadapted to accommodate the walls of the blood vessel being sutured.Provision is made on an end face 32 (FIGS. 3, of the staple semibushesfor radial slots 33, which accommodate movably mounted magazines 34 withrecesses 35 for staples 36, said magazines incoproating thereinsideejectors 37 to eject the staples 36.

The magazines 34 and the staple ejectors 37 are provided with mechanicalactuators for being moved in radial directions. Said mechanicalactuators are made as magazlne semirings 38 (FIGS. 4, 5) and staplesemirings 39 (FIGS. 3, 5), both being made swivel with respect to thestaple semi-bushes 10. The magazine semirings 38 (FIG. 4) have slopinggrooves 40 adapted to receive shanks 41 provided on the magazines 34,whereas the staple semirings 39 (FIG. 3) have sloping spiral grooves 42adapted to receive shanks 43 provided on the staple ejectors 37.Swivelling motion of the magazine semirings (F IG.4) results in radialmotion of the magazines 34, while swivelling motion of the staplesemirings 39 (FIG. 3) causes radial motion of the staple ejectors 37.

The mechanical actuator of the magazine semirings 38 (FIG. 4) is made asa rod 44 movable lengthwise the staple body 5 and mounted in a slotthereof.

One end of the rod 44 is provided with a helical thread adapted tointeract with a sliding nut 45 (FIGS. 1, 4) having an annular recess 46,whereby said nut gets engaged with an edge 47 of the staple body 5 andis thus prevented from moving lengthwise of the latter.

The other end of the rod is provided with a sloping groove 48 (FIG. 4)adapted to interact with a projection 49 provided on the magazinesemiring 38.

The mechanical actuator of the staple semirings 39 (FIG. 3) is made as aswivel toothed segment 50 provided with an actuating lever 51 rotatableabout a pivot pin 52.

The toothed segment 50 is adapted to interact by its teeth 53 withprojections 54 which are affixed on the staple semirings 39. To bringthe staple semirings into the initial position, provision is made for areturn spring 55.

The interchangeable supporting semibushes 21 (FIGS. 4, 6) are of thefollowing design:

On a cylindrical surface 56 (FIGS. 1, 3) of the supporting semibushes 21are provided depressions 57 for staples to bend so that a centre line 58(FIG. 1) thereof makes right angles with the generatrix of thecylindrical surface 56.

When the staple part 1 and the supporting part 2 (FIG. 3) of theinstrument are interlocked, the supporting semibushes 21 (FIG. 3) enterthe stable semibushes 10, with the result that the depressions 57 arepositioned exactly against the radial slots 33.

To fix the end of the blood vessel being sutured the supportingsemibushes 21 are provided with lugs 59.

To avoid breakage of the staple ejectors 37 (FIG. 3)

which might result from an unlimited travel of the actuating lever 51,as well as to coordinate the movement of the staple ejectors 37 withthat of the magazines 34 which are advanced towards the supportingsemibushes 21 when the suturing gap is to be varied to suit the wallthickness of the tissues being sutured, provision is made in theinstrument for a self-acting limiter of the movement of the stapleejectors 37, fashioned as a stop 60 (FIGS. 3, 4, 6) fixed in position onthe movable rod 44 and adapted to co-operate with the curvilinearsurface of a projection 61 provided on the actuating lever 51 (FIG. 4).

The herein-proposed surgical instrument operates as follows.

The supporting semibushes 21 and the staple semibushes 10 correspondingthereto, are selected to suit the dimensions of the blood-vessel to besutured, whereby the outside diameter of the joined semibushes 21 beapproximately equal to the vessel inside diameter.

Then one of the supporting semibushes 21 is mounted on the supportingbody 4 and the other, on the carrier strip 22 so that the shank 23 ofthe supporting semi-bushes 21 enters the holes 24 and 25, and, theprojections 27 of the blade springs 28 engage the grooves 26.

Further, the carrier strip 22 gets interlocked with the supporting body4 and fixed in that position by the locking strip 30.

As a result, the supporting semibushes 21 form the cylindrical bore 29for the blood vessel being sutured to be accommodated.

One of the staple semibushes 10, like the supporting semibushes 21, ismounted on the staple body 5, while the other semibush is mounted on thecarrier strip 1 1.

Thereupon, an exposed vessel end 62 (FIG. 7) is passed inside thesupporting semibushes 21 and everted as a cuff whose edges are pinneddown on the lugs 59.

The other vessel end 63 (FIG. 8) is folded back over the previouslyformed cuff and is pinned down on the same lugs 59.

The staple body 5 (FIG. 1) is interlocked with the supporting part 2.

After that, the carrier strip ll'is brought together with the staplebody 5 and locked by means of the locking strip 19.

The vessel ends 62 and 63 (FIG. 9) approximated by their inner membranes(intima-to-intima), are arranged in between the supporting semibushes 21and the staple semibushes 10.

An extent of gap required for suturing is set by rotating sliding nut 45(FIG. 4) which causes the rod 44 to move towards the staple semibushes10. As aresult, the projection 49 made fast on the magazine semiring 38,slides along the sloping groove 48 of the rod 44, thus making arotational movement with respect to the staple semibushes 10.

At the same time the magazine semirings 38 acting through the slopinggrooves 40, cause the shanks 41 of the magazines 34 to move in radialdirections along the radial slots 33. Rotation of the sliding nut 45 isnot ceased until an edge 64 (FIG. 9) of the magazine 34 gets in touchwith the vessel wall. At this moment the staple ejector 37 is to beadvanced to such a position that its edge 65 coincides with the edge 64of the magazine 34 which is necessary for the staple to be completelydriven out to obtain good-quality suture.

When setting the suturing gap, the stop 60 fixed on the rod 44 is movedalong with the rod 44 (FIG. 4) towards the staple semibushes 10, toassume a difinite position with respect to the body 5 which depends uponthe adapted suturing gap.

Suturing is performed in a single stage by pressing down the actuatinglever 51 (FIG. 3).

This results in the swivel toothed segment 50 turning around the pivotpin 52, thereby causing the teeth 53 of the segment 50 to act upon theprojections 54 of the staple semirings 39, thus causing the latter toturn with respect to the staple semibushes 10.

The staple semirings 39 act through the sloping grooves 42 upon theshanks 43 of the staple ejectors 37, thus causing the latter to movelengthwise of the staple recesses 35 of the magazines 34.

The ejectors 37 drive out the staples 36 the prongs of which penetratethe vessel walls and, upon thrusting against the bending depressions 57,get bent to assume the required B-shape, thus firmly securing the vesselends.

The actuating lever 51 (FIG. 4) keeps moving until the projection 61provided on the actuating lever, engages the stop 60 located on themovable rod 44.

The curvilinear surface of the projection 61 is so selected that thestop 60 should meet the projection 61 just at the moment when the edge65 (FIG. 9) of the staple ejector 37 coincides with the edge 64 of themagazines 34. As a result, the staple 36 will thus be driven outcompletely from the magazine 34, whereby highquality single-motionsuturing of the vessel blood vessel ends is performed round the entirecircumference of the assembled ends of the blood vessels.

What is claimed is:

1. A surgical instrument for suturing to join cut ends of a blood-vesselwith U-shaped staples, comprising: a supporting part of the instrument;a carrier strip on said supporting part; first and second supportingsemibushes, said first supporting semibush being fixed to saidsupporting body and said second semibush being fixed to said carrierstrip, said first and second semibushes, when assembled forming acylindrical bore for accommodating the blood-vessel being sutured;depressions for deforming free ends of the U-shaped staples being formedon an outside cylindrical surface of each said supporting semibush; astaple part of the instrument comprising a staple body and a carrierstrip; first and second staple semibushes of which the first one isfixed to said staple body and the second secured to said carrier strip,said first and second staple semibushes when assembled concentrically ofsaid supporting semibushes from outside forming an annular gap inbetween said supporting and said staple semibushes to accommodate thewalls of the blood-vessel being sutured; radial slots in said staplesemibushes located opposite said respective depressions in saidsupporting semibushes; magazine means located in said radial slots forstoring and holding U-shaped staples; staple recesses in said magazines;staples ejectors accommodated in said magazines; two magazine semiringsformed to swivel with respect to the staple semibushes; sloping groovesin said magazine semirings; shanks on said magazines adapted to interactwith said sloping grooves so that swivelling motion of said magazinesemirings results in radial reciprocating motion of said magazines,manually actuated means for imparting swivelling motion to said magazinesemirings; and means to impart radial motion to said staple ejectorscomprising two staple semirings made to swivel with respect to thestaple semibushes; sloping grooves in said staple semirings; shanks onsaid staple ejectors adapted to interact with said grooves in the staplesemirings so that swivelling motion of said staple semirings results inradial reciprocating motion of said staple ejectors, and manuallyactuated means for imparting swivelling motion to said staple semirings.

2. A surgical instrument as claimed in claim 1, wherein said means forimparting swivelling motion to said magazine semirings comprises: a rodmovable lengthwise of said staple body: threading provided on one end ofsaid rod; a sloping groove at the other end of said rod; a nut providedto co-operate with said threading; and a projection formed on one ofsaid mag azine semirings and adapted to interact with said slopinggroove at said. other end of said rod.

3. A surgical instrument as claimed in claim 1, wherein said means forimparting swivelling motion to said staple semirings comprises: amanually actuated pivoted lever having a toothed segment; and projectionmeans on said staple semirings for co-operating with said toothedsegment.

4. A surgical instrument as claimed in claim 2, further provided with aself-acting limiter of motion of said staple ejectors to coordinate themotion of said staple ejectors with that of said magazines, said limitercomprising a stop fixed on said rod and a projection having acurvilinear surface and located on the actuating lever, said projectionbeing adapted to engage said stop.

1. A surgical instrument for suturing to join cut ends of a blood-vesselwith U-shaped staples, comprising: a supporting part of the instrument;a carrier strip on said supporting part; first and second supportingsemibushes, said first supporting semibush being fixed to saidsupporting body and said second semibush being fixed to said carrierstrip, said first and second semibushes, when assembled forming acylindrical bore for accommodating the blood-vessel being sutured;depressions for deforming free ends of the U-shaped staples being formedon an outside cylindrical surface of each said supporting semibush; astaple part of the instrument comprising a staple body and a carrierstrip; first and second staple semibushes of which the first one isfixed to said staple body and the second secured to said carrier strip,said first and second staple semibushes when assembled concentrically ofsaid supporting semibushes from outside forming an annular gap inbetween said supporting and said staple semibushes to accommodate thewalls of the bloodvessel being sutured; radial slots in said staplesemibushes located opposite said respective depressions in saidsupporting semibushes; magazine means located in said radial slots forstoring and holding U-shaped staples; staple recesses in said magazines;staples ejectors accommodated in said magazines; two magazine semiringsformed to swivel with respect to the staple semibushes; sloping groovesin said magazine semirings; shanks on said magazines adapted to interactwith said sloping grooves so that swivelling motion of said magazinesemirings results in radial reciprocating motion of said magazines,manually actuated means for imparting swivelling motion to said magazinesemirings; and means to impart radial motion to said staple ejectorscomprising two staple semirings made to swivel with respect to thestaple semibushes; sloping grooves in said staple semirings; shanks onsaid staple ejectors adapted to interact with said grooves in the staplesemirings so that swivelling motion of said staple semirings results inradial reciprocating motion of said staple ejectors, and manuallyactuated means for imparting swivelling motion to said staple semirings.2. A surgical instrument as claimed in claim 1, wherein said means forimparting swivelling motion to said magazine semirings comprises: a rodmovable lengthwise of said staple body: threading provided on one end ofsaid rod; a sloping groove at the other end of said rod; a nut providedto co-operate with said threading; and a projection formed on one ofsaid magazine semirings and adapted to interact with said sloping groOveat said other end of said rod.
 3. A surgical instrument as claimed inclaim 1, wherein said means for imparting swivelling motion to saidstaple semirings comprises: a manually actuated pivoted lever having atoothed segment; and projection means on said staple semirings forco-operating with said toothed segment.
 4. A surgical instrument asclaimed in claim 2, further provided with a self-acting limiter ofmotion of said staple ejectors to coordinate the motion of said stapleejectors with that of said magazines, said limiter comprising a stopfixed on said rod and a projection having a curvilinear surface andlocated on the actuating lever, said projection being adapted to engagesaid stop.